MEDICARE: ROSS THOMAS SEITTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	973054940	OTHER	MO	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1194280230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSS THOMAS SEITTER

Provider Business Mailing Address
First Line	:	3472 HIGHWAY Y
Second Line	:
City	:	NEW HAVEN
State	:	MO
Zip	:	63068-2402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3472 HIGHWAY Y
Second Line	:
City	:	NEW HAVEN
State	:	MO
Zip	:	63068-2402
Country	:	US
Telephone Number	:	636-221-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2019
Last Update Date	:	02/03/2019

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Directions to “ ROSS THOMAS SEITTER ” Practice Location

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